Improving obesity prevention and treatment in GPS clinic

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Improving obesity prevention and treatment in GPS
clinic

• H Sonali Magdo, DO
• PGY 2
• CHLA

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BackgroundPrevalence of obesity in American
children1
1999-2000 2003-2004
Girls 13.8 16
Boys 14 18.2
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Health consequences of obesity in childhood5,6

• Type II DM
• Hypertension
• OSA
• Depression/low self esteem
• Nonalcoholic fatty liver disease
• SCFE
• Pseudotumor cerebri

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Objectives

• 1. Review existing literature on childhood
  obesity
• 2. Identify the obstacles faced by physicians in
  a general pediatrics clinic in assessing and
  treating children who are overweight through use
  of survey
• 3. Provide physicians in GPS clinic with
  resources to improve prevention/ management of
  overweight and obesity

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Assessment of PCP management of obesity4

• Of all children who met criteria for obesity,
  only 53 of visits documented obesity
• 69 documented an adequate dietary history
• 15 documented activity level

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Medical history and PE
Condition pediatricians PNP
Hypertension 97 95
Type II DM 38 41
Genetic Syndromes 32 22
Sleep disorders 41 27
GI disorders 22 24
Orthopedic problems 38 46
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Survey ResultsBarriers to treatment of
obesity/overweight
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Survey results ?clinic resources

Survey Results 1. Lack of time to counsel
patients 2. Lack of clinic guidelines for
disease management 3. Lack of knowledge of
community programs
Intervention 1. Nutritional intake form 2a.
Creation of chart (adapted from
Pediatric Annals article) for
reference in clinic b. Weight check form 3.
Creation of booklet compiling community programs
for overweight/obese children in LA

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Clinic flow chart
Adapted fromAriza AJ, RS Greenberg, R Unger.
Childhood overweight management approaches in
young children. Pediatric Annals. January 2004
33(1) 33-38.
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Clinic weight check form

• ALTA MED WEIGHT CLINIC VISIT Place sticker
  here
• Date
• Vital signs
• Temp BP /
  (___) HR RR ___
• Weight (___) Height____ (____)
  BMI____ (_____) Previous BMI ____
  (____) on __/__
• Allergies Medications_______________________
  ______
• Do you see your child as ___ overweight ____
  normal weight ____ underweight?
• Diet History
• 1. How many meals a day do you eat?
  At the table, with whole family
  present? ______
• 2. What is the largest meal of the day?
  How many snacks do you eat per
  day? ______
• 3. How much juice do you drink?
  How much soda? ______
•  Activity History
• 1. How many hrs of TV do you watch?
  How many hours of video games/computer time?
  ______
• 2. How much exercise do you get?
  Exercise enough to sweat
  how many times/week? ______
• Medical History Questions
• 1.Obstructive sleep apnea Snoring?
  Gasping for breath at night/long
  pauses in breathing? _____
• 2. Shortness of breath with exertion? _____
• 3. Irregular/scant periods?
  Known history of PCOS?
  _______
• 4. Headaches? (pseudotumor cerebri) ______

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Clinic weight check form

• Focused physical exam
• HEENT Tonsillar hypertrophy
  ______ Dysmorphic features _______Papilledema____
  _
• Neck Palpable thyroid
  _______
• Lungs
• Heart
• Abdomen Hepatomegaly ______
• Skin Acne
  ____ Acanthosis nigricans ____ Hirsutism _____
  Striae _____
• Neuro Developmental delay
  ______
• Musculoskeletal Buffalo hump ______
  Digital anomalies ______ Spinal asymmetry ____
• Genu varum
  ______ Genu valgum ______
• GU Abnormal
  genitalia ______
• Labs Fasting glucose Lipid panel
  ________ Liver function panel______
• Thyroid function tests (if linear
  growth is poor, family hx, palpable thyroid)_____
• Referrals
• ____ ENT (OSA, disordered sleep breathing) ____
  Overnight Sleep Study
• ____ Cardiology (Dyspnea on exertion, LDL gt
  110mg/dl, FHx, BP gt 95 for height and gender
  on 3 visits)
• ____ Endocrinology
• ____ Orthopedics/PT(Spinal asymmetry, genu
  varum/valgum)
• ____ Genetics (DD, dysmorphic, abnormal
  genitalia, digital anomalies)

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Clinic recommendations
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Future projects

• Evaluation of success of project
• Survey of patients and their families
• Creation of webpage linked to CHLA website to use
  for resources in the community
• Creation of nutrition and activity handouts that
  are culturally sensitive

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Thank you!

• Susan Wu, MD
• Larry Yin, MD
• Hope Wills, RD
• Esther Berenhaut, RD
• Yvonne Gutierrez, MD

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References

• 1. Ogden, CL, Carroll MD, Curtin LR et al.
  Prevalence of overweight and obesity in the
  United States, 1999-2004. JAMA. 2006 Apr 5 295
  (13) 1549-1555.
• 2. Ariza AJ, RS Greenberg, R Unger. Childhood
  overweight management approaches in young
  children. Pediatric Annals. January 2004 33(1)
  33-38.
• 3. Committee on Nutrition. Cholesterol in
  childhood. Pediatrics. Jan 1998 101(1) 141-147.
• 4. Obrien SH, R Holubkov, EC Reis.
  Identification, evaluation and management of
  obesity in an academic primary care center.
  Pediatrics. Aug 2004 114(2) e154-e159.
• 5. Dietz WH. Health consequences of obesity in
  youth childhood predictors of adult disease.
  Pediatrics. Mar 1998 101(3pt2) 518-525.
• 6. Hoppin, AG, ES Katz, LM Kaplan, GY Lauwers.
  Case 31-2006 A 15-year-Old girl with severe
  obesity. NEJM. Oct 2006 355(15) 1593-1602.